Veterinary Services (VS) Forms

FORM NO.

EDITION DATE

TITLE

CONSTRUCTION

UNIT OF ISSUE

SOURCE OF SUPPLY

VS 1-2

04/73

Herd History Card

CD

PKG (100)

BSC

VS 1-4

01/76

Identification Card

CD

EA

VS

VS 1-9-R

09/90

Fee Basis Agreement

CS

EA

LRA

VS 1-14

10/75

Shipping Permit Envelope

ENV

HD

BSC

VS 1-16

02/77

Tuberculosis ID Card

CD

PKG (100)

NVSL

VS 1-23

05/84

Appraisal and Indemnity Claim for Animals Destroyed/Materials Destroyed

Set 5

PKG (100)

BSC

VS 1-23A

05/84

Continuation Sheet - Indemnity Claim for Animals Destroyed/Materials Destroyed

Set 5

PKG (100)

BSC

*VS 1-24

07/97

Proceeds for Animals Sold for Slaughter

CS

PAD (50)

BSC

*VS 1-27

06/89

Permit for Movement of Restricted Animals

Set 5

BKS (25)

BSC

VS 1-27A

09/91

Permit for Movement of Animals Continuation Sheet

Set 5

EA

VS (MS&TX)

VS 1-31

08/79

Indemnity Claim Transmittal

CS

PAD (100)

BSC

VS 1-36

06/98

Veterinarian Accreditation Certificate

CS

PKG (50)

BSC

*VS 1-36A

07/97

Application for Veterinary Accreditation

CS

PKG (50)

BSC

VS 1-41

03/98

Approved Livestock Facility Certificate

CS

PKG (25)

VS

VS 1-61

05/90

Record of Animal Identification (Ear) Tags Issued

CS

PKG (25)

MRPBS (MN)

VS 1-62

01/74

Record of Animal Identification (Ear) Tags Applied - Numbered

CD

Set (200 Cards)

MRPBS (MN)

VS 1-80

10/77

Description of Purebred Animals - Cattle

CS

PAD (100)

BSC

VS 1-86

12/76

Warning Tag

Tag

PKG (50)

BSC

VS 1-86A

09/74

Cleaned, Washed, and Disinfected Tag

Tag

PKG (50)

BSC

VS 2-11

09/96

Report of Diseased Animals Found at Slaughter Establishment

Set 4

BKS (25)

BSC

VS 2-24D

03/76

Application for Supervision of Dipping of Animals and Waiver for Loss or Damage Therefrom

Set 2

BKS (25)

BSC

VS 2-57G

08/73

Clean and Disinfect This Pen

CD

EA

BSC

VS 3-70-R

05/92

Civil Penalty Stipulation Agreement

CS

EA

LRA

VS 3-577-R

12/74

Violations 28-Hour Law

CS

EA

LRA

VS 3-578-R

09/74

Report of Alleged Violation of 28-Hour Law

CS

EA

LRA

*VS 4-1

12/88

Application for Brucellosis Certification or Reclassification of State

CS

PKG (100)

BSC

*VS 4-1D

03/90

Application for Validation of a Brucellosis-Free Area

CS

EA

BSC

*VS 4-6

07/76

Telecopier Justification for Brucellosis Herd Depopulation

CS

EA

MRPBS (MN)

VS 4-7

08/81

Agreement for Complete Herd Depopulation-Brucellosis

CS

EA

LRA

VS 4-13

11/72

Certified Herd - Cooperative Brucellosis Eradication

CS

PKG (100)

BSC

VS 4-24

08/83

Brucellosis Calfhood Vaccination Record (Short Form)

Set 4

BKS(25)

BSC

VS 4-26

07/83

Brucellosis Vaccination Record

Set 4

PKG (100)

BSC

VS 4-33

02/92

Brucellosis Test Record

Set 5

PKG (50)

BSC

VS 4-33A

02/92

Brucellosis Test Record - Continuation Sheet

Set 5

PKG (50)

BSC

VS 4-34

09/88

Brucellosis Test Record

Set 5

CTN (Con)

BSC

VS 4-37

12/75

Brucellosis Ring Test Work Form

CD

EA

BSC

VS 4-39

09/74

Brucellosis Ring Test Patron List

Set 4

PKG (50)

BSC

VS 4-42-R

09/74

Specifically Approved Stockyard Inspection Report

CS

EA

LRA

VS 4-52

07/74

Report of Backtags Applied (Prenumbered from 0001 to 9,999)

CS

PKG (400)

BSC

VS 4-52A

02/73

Report of Backtags Applied (Unnumbered)

CS

PKG (100)

BSC

VS 4-53

06/73

Blood Sample Transmittal Slip for Market Cattle Testing

CS

PAD(50)

BSC

VS 4-54

07/81

Brucellosis Test Record - Market Cattle Testing Program

Set 4

PKG (100)

BSC

*VS 4-59

06/91

Quarterly Report of Swine Brucellosis Eradication Activities

CS

EA

MRPBS (MN)

VS 4-92

01/80

Brucella Abortus Aglutination Check Test Results

Set 5

PAD(25)

BSC

VS 4-100

10/76

Log for Market Cattle Test Reactors

CS

EA

BSC

VS 4-106

10/74

Field Investigation of Brucellosis Market Test Reactor(s)

Set 4

PKG (50)

BSC

*VS 4-108

08/89

Epidemiologic Investigation of Brucellosis Reactor Herd

Set 4

PKG (50)

BSC

*VS 4-108A

10/80

Origin of Reactor/Herd Addition

Set 4

PKG (50)

BSC

*VS 4-108B

10/80

Animals Removed from Infected Herd

Set 4

PKG (50)

BSC

*VS 4-108C

05/89

Epidemiology Report - Suspect Herd

Set 4

PKG (50)

BSC

VS 5-18

09/92

Record of Animals Moved

Set 2

PKG (50)

BSC

VS 5-19

07/93

Flock Inspection and Epidemiology Report

Set 2

PKG (50)

BSC

VS 5-20

05/94

Individual Animal Information Report

Set 2

PKG (50)

BSC

VS 5-21

08/92

Agreement to Conduct the Official Histopathology Examination for the Diagnosis of Scrapie in Sheep and Goats and Bovine Spongiform Encephalopathy in Cattle

CS

EA

NVSL

VS 5-22

08/92

Application for the Scrapie Flock Certification Program

Set 4

PKG (50)

BSC

VS 5-23

08/92

Application for Advancement of Status Scrapie Flock Certification Program

Set 4

PKG (50)

BSC

VS 5-26

05/77

Summary of Serological Test Results

CS

PKG (25)

BSC

VS 6-2-R

04/97

Report of Tuberculosis Eradication

CS

EA

LRA

VS 6-4

11/73

Report of Herd Revealing Reactors to Tuberculin Test

CS

PAD(100)

BSC

VS 6-4A

07/73

Investigation for Evidence of Tuberculosis (Reactor)

CS

PAD(100)

BSC

VS 6-4B

07/82

Investigation for Evidence of Tuberculosis (Exposed Animal)

CS

PAD(100)

BSC

VS 6-4B-R

(cont.)

11/80

Investigation for Evidence of Tuberculosis (Exposed Animal - Continuation)

CS

EA

LRA

VS 6-14

11/94

Accredited Herd Certificate - Cooperative Tuberculosis Eradication

CS

PKG (50)

BSC

*VS 6-22

02/99

Tuberculosis Test Record

Set 5

PKG (50)

BSC

*VS 6-22A

02/99

Tuberculosis Infected Herd (Field Report)

CS

PAD(100)

BSC

*VS 6-22B

02/99

Tuberculosis Test Record (Continuation)

Set 5

PKG (50)

BSC

*VS 6-22C

02/99

Tuberculin Test Record (Special)

Set 5

PKG (50)

BSC

*VS 6-22D

02/99

Comparative Cervical Tuberculin Test Results

Set 3

PKG (100)

BSC

VS 6-35A

11/72

List of Consignors for Lot of Cattle Reported on VS Form 6-35

CS

PAD(50)

BSC

VS 6-35B

01/74

Closing Report of Herd Investigation of TB Lesions or Thoracic Granulomas in Regular Kill Animals

Set 5

PKG (50)

BSC

*VS 6-38

05/73

Accredited Area Surveillance for Tuberculosis

CS

EA

BSC

*VS 7-1

04/90

Quarterly Report of Pseudorabies Control/Eradication Activities

CS

PKG (25)

BSC

VS 8-1

10/89

Request for Clearance/Approval of Issuance

Set 2

PKG (200)

VS

VS 8-2

10/89

Summary of Issuance Comments

Set 2

PKG (25)

VS

VS 8-18

03/79

Statement of Services Performed

Set 3

PKG (50)

BSC

VS 8-19

10/90

Checklist of Amounts Payable to Fee-Basis Veterinarians

Set 3

CTN(500)

BSC

VS 8-35

04/79

Weekly Field Activity Report

CS

PKG (100)

BSC

VS 8-81A

01/97

Report of Reimbursable Inspection and Quarantine Service Worksheet

Set 3

PKG (50)

BSC

*VS 9-2

05/97

Flock Selecting and Testing Report

Set 4

BKS(25)

BSC

*VS 9-3

06/98

Report of Sales of Hatching Eggs, Chicks, and Poults

Set 4

BKS(25)

BSC

*VS 9-4

08/89

Summary of Breeding Flock Participation

CS

EA

VS

*VS 9-5

03/81

Report of Hatcheries, Dealers and Independent Flocks Participating in the NPIP

CS

EA

VS

VS 9-7

03/81

Investigation of Salmonella Isolations in Poultry

CS

PAD(50)

VS

VS 9-8

10/96

Flock Inspection and Check-Testing Report

Set 4

BKS(25)

BSC

VS 9-9

06/85

Hatchery Inspection Report

Set 3

BKS(25)

BSC

VS 10-1

04/86

Biological Shipment Receipt Verification (BRM)

CD

EA

FADDL

VS 10-9

11/72

Report of Complement - Fixation Tests for Anaplasmosis

Set 5

PKG (50)

BSC

VS 10-11

05/00

Equine Infectious Anemia Laboratory Test

Set 5

BKS(50)

BSC

VS 10-12T

10/97

Equine Infectious Anemia Supplemental Investigation

MP

PKG (25)

BSC

VS 10-13

1/01

Owner/Shipper Certificate - Fitness to Travel to a Slaughter Facility

CS

PAD(100)

BSC

VS 10-21

03/73

Emergency Program Specimens

LBL

PKG (200)

NVSL

VS 10-23

04/93

Retained

LBL

STR (3)

NVSL

VS 10-24

03/73

Biomedical Material (Perishable)

LBL

STR (5)

BSC

VS 10-27

01/93

Dry Ice

LBL

PKG (100)

NVSL

VS 10-28

03/92

Label "Contents of Package"

LBL

PKG 100)

NVSL

VS 10-29

08/88

Label "Animal Diagnostic Specimen"

LBL

PKG (100)

BSC

*VS 12-27

01/93

Field Investigation (READI) (Electronic version available)

CS

PKG (25)

BSC

VS 13-2

03/85

Swine Health Protection Inspection Summary

CS

EA

BSC

VS 13-9

09/73

Inspection Report of Garbage Processing Equipment

CS

EA

BSC

*VS 13-15

09/88

Application for Licensing of Garbage Treatment Facility

Set 3

PKG (50)

BSC

*VS 13-16

02/90

Garbage Treatment Facility Inspection

Set 3

PKG (50)

BSC

VS 13-17

07/88

Food Waste Report

CD

EA

VS

VS 14-17

03/74

Official Export Certificate for Animal Biological Products

CS

PAD(50)

VS

VS 14-21

10/73

Samples Inventory Record

Set 3

EA

NVSL

*VS 16-3

03/95

Application for Permit to Import Controlled Material/Import or Transport Organisms or Vectors

CS

PKG (25)

BSC

VS 16-4

03/04

Export Certificate Animal Products

Set 6

PKG (25)

BSC

VS 16-6

11/93

United States Veterinary Permit for Importation and Transportation of Controlled Materials and Organisms and Vectors (Green)

CS

PKG (100)

BSC

VS 16-6A

11/93

United States Veterinary Permit for Importation and Transportation of Controlled Materials and Organisms and Vectors (Blue)

CS

PKG (100)

BSC

VS 16-7

03/95

Additional Information for Cell Cultures and Their Products

CS

EA

VS

*VS 16-24

10/73

Application for Inspection and Certification of Animal Byproducts

CS

EA

MRPBS (MN)

*VS 16-25

07/73

Application for Approval or Report of Inspection Establishment Handling Restricted Animal Byproducts or Controlled Materials

CS

EA

BSC

*VS 16-26

06/96

Agreement for Handling Restricted Imports of Animal Byproducts and Controlled Materials

CS

PKG (25)

BSC

VS 16-78

10/72

Report of Entry, Shipment, and Final Disposition Restricted Imported Meats, Animal Byproducts and Other Material

Set 4

PKG (100)

BSC

*VS 17-6

09/95

Certificate for Poultry or Hatching Eggs for Export

Set 5

PKG (50)

BSC

*VS 17-8

01/90

Agreement of Pet Bird Owner

Set 4

PKG (50)

BSC

*VS 17-11

11/94

Application for Quarantine Facility for Birds

CS

PKG (25)

BSC

*VS 17-12

11/94

Daily Log for Birds Quarantine Facility

CS

PKG (50)

BSC

VS 17-13

10/78

Summary of Quarantine Birds

CS

PAD(50)

BSC

*VS 17-20

06/98

U.S. Application/Permit to Import Birds

Set 7

PKG (25)

BSC

*VS 17-23

08/89

Importation of Pet Birds (Personally Owned)

Set 4

PKG (50)

BSC

VS 17-25

08/76

Warning - Export Animal Facility

CD

EA

MRPBS (MN)

*VS 17-29

07/95

Declaration of Importation for Animals, Animal Semen, Birds, Poultry and Eggs for Hatching

CS

PAD (100)

BSC

VS 17-30

04/73

Report of Animals, Poultry, or Eggs Offered for Importation

Set 5

BKS(25)

BSC

VS 17-30E

07/73

Quarterly Record - Import Animals and Poultry - Air and Ocean Ports

CS

PAD(50)

BSC

VS 17-31

05/73

Dourine and Glanders Import Test Record

Set 4

PKG (50)

BSC

*VS 17-32

01/95

Application for Inspection and Dipping

CS

PAD(50)

BSC

VS 17-33

10/83

Animals Imported for Immediate Slaughter

Set 4

BKS(25)

BSC

VS 17-33A

04/76

Imported Livestock for Immediate Slaughter

CD

PKG (50)

BSC

VS 17-36

06/77

Inspection Report of Establishment for Immediate Slaughter Import Animals

Set 4

EA

BSC

VS 17-37

07/77

Certificate of Inspection of Export Animals

Set 6

BKS(20)

BSC

VS 17-41

06/78

Notice of Animals Not Shipped

Set 5

PKG (100)

BSC

VS 17-46

12/77

Report of Birds Offered for Importation

Set 5

PKG (50)

BSC

*VS 17-65A

08/94

Zoological Park Inspection Report

CS

EA

MRPBS (MN)

*VS 17-65B

08/73

Agreement for the Importation, Quarantine and Exhibition of Certain Wild Ruminants and Wild Swine

CS

EA

VS

*VS 17-65C

12/90

Permanent Quarantine Record of Zoo Animals

PD (Set)

PAD(25)

BSC

VS 17-65D

01/95

Agreement for the Transfer of Certain Wild Animals

CS

EA

VS

VS 17-70

11/94

Quarantine Facility Inspection Report

CS

PKG (25)

BSC

VS 17-80

05/85

Permit Label-Baby Chicks/Hatching Eggs from Canada

LBL (Con)

EA

VS

VS 17-128

12/94

Application/Permit for Ratite(s) or Ratite Hatching Eggs and Space Reservation Request

MP

PKG (100)

VS

*VS 17-129

05/96

Application for Import or in Transit Permit (Animals, Animal Semen, Poultry, and Hatching Eggs)

CS

PKG (50)

BSC

VS 17-134-R

05/85

United States Permit to Import Day Old Chicks and Poultry Hatching Eggs from Canada

CS

EA

LRA

VS 17-135

08/73

United States Permit to Import

Set 6

PKG (50)

BSC

*VS 17-135A

01/95

United States Permit to Transit Poultry, Pigeons, Hatching Eggs or Birds

CS

PKG (25)

BSC

*VS 17-140

03/98

U.S. Origin Health Certificate

Set 5

PKG (50)

BSC

*VS 17-140A

03/98

U.S. Origin Health Certificate (Continuation Sheet)

Set 5

PKG (100)

BSC

VS 17-145

05/00

U.S. Origin Health Certificate for the Export of Horses from the U.S. to Canada

Set 5

PKG (50)

BSC

VS 19-5-R

12/74

Report on Individual Horse Show/Sale

CS

EA

LRA

VS 20-1

04/94

Permit for Movement of Restricted Poultry and Poultry Products

Set 5

BKS 25

BSC

VS 20-4

04/94

Agreement to Conduct the Official Tests for SE Serotype Enteritidis

CS

EA

NVSL

VS 22-3

12/93

VS NCR Computer Paper

Set 5

CTN (550)

BSC

VS 22-4

04/94

Agreement to Conduct the Official Tests for Salmonella Enteritidis Serotype Enteritidis

CS

EA

NVSL

VS 22-31

11/94

Notice of Receipt of Application

Set 3

PKG (25)

BSC

*APHIS 2020

07/90

Shipment and Receipt of Biologics Samples

Set 4

PKG (50)

NVSL

APHIS 2032

01/90

Detained Veterinary Biological Product

Tag

PKG (50)

VS

APHIS 2033

01/90

Notice of Detention/Destruction of Veterinary Biological Products

Set 6

PKG (50)

VS

APHIS 2045

02/90

Product Destruction Record

Set 2

PKG (50)

VS

APHIS 7001

11/91

United States Interstate and International Certificate of Health Examination for Small Animals

Set 6

PKG (50)

BSC

APHIS 7001A

09/93

United States Interstate and International Certificate of Health Examination for Small Animals

Set 6

PKG (50)

BSC

APHIS 7015-R

05/94

Blood Sample Accountability Claim of Custody

CS

EA

LRA

APHIS 8022

05/89

Type of Examination Requested for Specimens Enclosed

LBL

STR(3)

NVSL

APHIS 8060

10/90

Laboratory Inspection Worksheet

Set 3

EA

NVSL

APHIS 8061

10/90

Inspection Worksheet for Approved Laboratories

Set 3

EA

NVSL